DIFFICULT IV: 5 TIPS TO KNOW

Just wanted to say thanks again for that "bend the needle" trick. I had to put an IV in a distal tibial vein today, and couldn't get the angle right even with the patient plantarflexing her foot. A little curve in the needle gave me the extra 5° I needed for a successful insertion. <3

Just use the jagular

Dear sir why veins not clear in nephro patient?

If this are what you call difficulty lines,then you are a quack

I’ve had all those tricks except the needle bending is not allowed where I live. That’s a lawsuit waiting to happen. Even my EJs are scarred to the point of having 3-6 attempts on any given Tuesday. I have had 3 ports but each one has gotten septic eventually. They’re either going to have to put another one in and risk infection or put me on hospice at this point in time. I can’t get an IO because I’m a paraplegic and the hospitals in my area won’t use my legs for any kind of access. One hospital stay for 33 hours I was stuck 35 times. That’s when they finally decided to go the port route.

I'm not a medical professional but a substance user who's currently using a bit of Cocaine once a fortnight. (got off heroin in 2004) but anyway, i was looking at this cos i love all things medical especially this subject because although i'm self taught, i will have some bad habits but I tend to be better than the phlebotomy nurses in UK as they are restricted to only veins on the arms. So I need an anethetist to get it. They are the best. Or i can do it but they no longer allow me too.

Can we use BP cuff instead of tornicate for difficult IV line

Is there an alternative to esmarch? We don’t have that in the ward. I tried the bent needle technique before and failed.

ER RN/Paramedic here-
I've used a manual blood pressure cuff, pumped up just above the diastolic reading to really get the distal vein engorgement in very difficult IV starts. The one bad thing about that- if you hit the vein but are unable to cannulate it, you will have a more impressive hematoma to deal with.

Greetings form Italy❤️

Thank you so much.

I want my epidural in my hand like an IV drip I don’t want it in my back

Hello sir... Thank you for your videos I'm an anesthesia student... I have a question for people with general edema in icu... They're really hard to find an iv access... Any tips?

Thank you for your videos! I am a CCMA student in the USA. We use tourniquets, but I have never heard of "s mark". I see and understand how it works, but I am wondering if this is used in hospitals only, or maybe the USA just doesn't use them yet? Is it an old or new practice?

Trying not to be racist, but doing an iv channel is much easier on a light skinned person than a dark one. 💀

Сделайте, пожалуйста, субтитры

Excellent videos!

I’ve had bad veins my entire life and I can’t say enough about the vein finder. I have tiny fragile veins. I learned to use breathing techniques to not panic because of a life time of trauma. I think the worst is people “trying” four of five tries post surgery and I’m crying. Then they start suggesting that it’s my fault.

Excelente todos los videos de esta serie, muchas gracias, igualmente por los subtítulos que ayudan mucho.

I’m a registered veterinary technician that works in emergency and critical care. I have a question; does bending the catheter compromise it in any way? And does it affect its ability to slide off of the needle? Thanks!

warming the extrimity ,use of gravity,use of alcohol while rubbing towards the torniquet, allowing some time for the veins to fill with blood, bending the needle, narrow angle, fast insertion,use of Esmarch , EJ,IO

wow a lot of alternative techniques i can try in my situation where the resources are limmited . Thank you so much .God bless you !

Is there a reason for the routine use of the brachial vein for the Ultrasound Guided piv? I would rather look for the basilic or cephalic vein first?

What about intravenous drug abusers??? We usually Don't found any vein for cannulation except central veins. Is there any technique available?

For me, its use my mediport or give me an I.O.

I have no veins its scary what will happen when I get old

Greetings from Germany! Some weeks ago we got an 90 yo woman in the ER who felt down the stairs and laid there for some hours. She had massive decollement wounds on both hands and forearms and her head. External jugular access was no option due to the high insertion angle from a prominent mandibula and skinny neck. So I bent a short 18G to cannulate 1st a tibial leg vein and 2nd at her shoulder as seen in your videos. Your advice was great! :) btw: bending needles is common practice here too.

Thanks!

I frequently utilize ultrasound-guided IV placement for patients with challenging veins. In fact, I haven't missed an IV insertion in several months (not kidding). When I can't find an easily accessible vein, I rely on the ultrasound to successfully insert the IV on the first attempt, eliminating the need for multiple attempts (from other people who cant do it). My skills are widely recognized, and I am often called upon to assist with IV placements throughout the entire hospital.

As a paramedic if I ABSOLUTELY need to get IV access for a unstable patient for medications I’ll go for the EJ if no other option is viable and I exhausted other methods. And obviously if the patient is unresponsive and absolutely necessary I’ll go for the humeral EZ-IO.

But thank you for your tips and videos, much appreciated!!

Say you dont have access to the esmark. Could you use wide coband wrap?

I guess some situation you need 18g needle or larger.

I'm an ICU RN and PACU RN and ever since I watched your videos, my PIV insertion success rate has increased to a 95% 1st attempt success rate. Bending the IV and taking time for the tourniquet to work is the key. I went from primarily using 20g ivs to 18g ivs. As well I placed my 1st 16g IV in a septic patient all because of your techniques. Thank you so much.

A couple of comments. Excellent video and series. The Esmarch technique is a great idea. I'd like to add another technique which I have incorporated for a long time. This is to use forced-air warming to make sure the patient is warm and perfusing their distal extremities. Distal limb blood flow varies greatly depending on a variety of factors - anxiety and hypovolemia of course, but thermoregulatory state is as important, if not more so. Forced-air warming of the entire patient for about 20 minutes can make a huge difference. This is much more effective than just warming the arm or hand. When I've been called to place an IV on a patient on the ward, the first thing I do is feel the temperature of their hands while looking for veins. If the hands are cold, 20 minutes of "Bair Hugger" will make all the difference. BTW, I bend the needle all the time too. I would disagree with the idea of "inserting the needle quickly". One gives up tactile feedback and unless you are incredibly accurate every time, there may not be enough time to see blood return before puncturing the other side of the vein. Do veins actually "roll"? I don't think so.

I have started using some of these techniques on the ambulance and have seen more success. In particular I tie the tourniquet first thing. While that dwells I get all my other iv stuff setup. Opening the packages, putting the extension set together and priming... after all that then I start looking for a vein.

Thank you

Geez I watch the older version of this vid, I kinda forgot to do this yesterday on a 84 y/o pt with CHF on TID Furosemide. I was in on the dorsum hand, but immediately I inserted it, my angle was too high and it went through and through. Thanks for the reminder, I won't forget this again

Thank you very much sir 🙏

I mean first 30 seconds 😅

Why don't u just come to the point

Does heat have a place on this list? Wrapping the arm in a heated blanket to warm it up?

Sorry, “S mark?” What’s that? I’ve never heard of it or seen one 😮

Hello Dr Hadzic. I am a French anesthesiologist, and since I have seen your old video, I systematically bend my intravenous catheter, which greatly improves my success. my colleagues are amazed, but it works. Thank you for your wise advice.

Elderly people do have sometimes thick vein walls and almost without a lumen, so it could be reasonable to use ultrasound not for guidance but for identification of the most suitable for successful puncture vein with the largest lumen ...

Nice video thank you..!

Nice information. I have become dependent on ultrasound 😅 trying to remedy this

🙏👍👍

I have been using the three tourniquet technique very successfully. I don't believe I have missed an IV start with difficult veins using this technique.